If your blood platelet levels are higher than average, your caregivers may worry that you could develop a blood clot in labour. The correspondence below describes Emma's experience of this condition during her second pregnancy, which combined with her history of a DVT (Deep Vein Thrombosis) which was unrelated to pregnancy, led her consultant to advise against home birth. The emails are from the Homebirth UK mailing list.
I am currently 32 weeks pregnant with my second baby and have requested a home birth. I had a very straightforward hospital birth with my first child using only gas & air and Meptid. After a dreadful experience on the postnatal ward I would rather deliver at home this time. However, I suffer from high platelets during pregnancy (this time they are at 409) for which they have found no reason and as a result my midwife is becoming negative about a home birth. I'm seeing my consultant on Tuesday to discuss both my blood and the birth and I'm hoping I'll still be able to get the birth I want...
... I had a DVT 3 years ago, totally unrelated to pregnancy and caused by smashing my pelvis, being on total bedrest for 5 weeks and the doctors ignoring me when I said I had calf pain. This was treated for 6 months to be on the safe side ... First pregnancy was 100% normal and although I took aspirin everyday and had fragmine in labour there were no problems at all.
With high platelets the blood will clot more easily so there is a risk of DVT but from what I've read that only really occurs if your levels go above 1000 and mine are 409. The cut-off point that they use here is 400. I have to take aspirin every day and then I have heparin in labour and for 6 weeks after but I sort out all the injections at home so hopefully that won't be a reason for going against a homebirth.
I'll just have to hope the consultant is in a good mood today.
Claire replied - she has experienced the opposite condition, ie low platelet levels in pregnancy:
My thought on this is that you should try to see a haematologist rather than an obstetric consultant about this condition (if you have not done so already) and ask their views on what risks they believe to be associated with high platelets to you during pregnancy, during labour, at the time of birth and afterwards, and the same questions in respect of the baby. What is the top of the normal range of platelets? I thought normal was 150-about 500?? I've given birth with 80. How high would your count need to be for the risks to become more serious?
If the risks are serious, there may be treatment you can have during your pregnancy to reduce the platelet count. In respect of whether to have your baby at home or in hospital you might want to find out what the probability of the "risky situation" occurring is, and what they could do for you in hospital that they could not do at home.
I would ask questions until you feel you really understand what you are being told - don't be fobbed off with a 'you've got high platelets so we don't really know what will happen, so you'd be better off in hospital' line. A registrar tried to scare my community midwives that I would bleed to death with my platelet count at my first birth. It took the intervention of an anti-homebirth GP and the consultant obstetrician (Wendy Savage) going back to her research notes to sort the situation out.
If you know the medical name for high platelet levels, search the internet for academic essays. There are a few good ones on thrombocytopaenia. Find out if there are differences between this condition occurring in pregnancy only, as opposed to in normal life.
If you do end up having regular blood tests, see if the nurse at your GP's surgery can take them. I didn't think about it and spent a morning a month in a hospital ward full of very sick blood patients ... not fun. I didn't have regular tests in pregnancies 2 and 3 as by then we were clear that I did not have the scary condition, just the cheap pregnancy-related imitation!
I saw my consultant earlier with regard to having a homebirth and my slightly elevated platelets.
She basically used scare tactics to tell me I couldn't have a homebirth because "what would happen if I was unconscious with a pulmonary embolism" She couldn't actually tell me if there were increased risks by being at home and she actually said that things would not be managed differently in hospital, except that having had one baby in that hospital there policy seems to be flat on your back to deliver with continuous monitoring.
I've been told I'll hear from a haemotologist within two weeks. Firstly the consultant told me that they would want to put me on heparin (I'm already on aspirin) then she said they'd probably do nothing. I feel like I'm being bullied into a birth that is going to be managed on a worst-case scenario basis.
The consultant didn't have answers for my questions; she just made me seem like I was putting myself at risk for having silly ideas. She pretty much told me that I would have a blood clot so to plan this birth like I have one!!!
What can I do?
Poor you! It's easy for me to say, but you can do whatever you want to do in the end. Remember it's your choice to give birth wherever you want to and if you want to have a home birth you can just say so to your midwife and not bother seeing this unpleasant consultant again. Remember, no-one can refuse you a home birth. It is your right to give birth wherever you want to.
Your consultant is not giving you the opportunity to make an informed choice by refusing to answer your valid questions about your condition. Perhaps the haematologist will be more helpful. Fingers crossed. If you still have unanswered questions which are preventing you from making an informed decision about your labour and your baby's birth, you could seek their help. If you think that would be like hitting your head against a brick wall, contact AIMS - www.aims.org.uk - who are keen to know about people having difficulty booking homebirths and are very helpful in relation to who you need to write to/complain to/appeal to to get the kind of care you want.
Did the consultant answer "what happens if you are unconscious with a pulmonary embolism?" in the hospital scenario?
Do you live close to your hospital? If you ARE worried about the worse case scenario, can you work out or find out whether treatment would be available quicker from the labour ward or from your home. Living in a small London borough, the midwives here reckon the time to theatre from any home is quicker than from labour ward as the midwife transferring a home birth would be listened to much more seriously and could have anaesthetist etc available when ambulance arrived ...
Do you know what your platelet count was during your last delivery?
What can you do? Whatever you want. It is not up to anyone else to refuse you a homebirth or permit you a homebirth - it is *your* choice.
I'm just putting 2 bits together that you wrote:
She couldn't actually tell me if there were increased risks by being at home and she actually said that things would not be managed differently in hospital,
She pretty much told me that I *would* have a blood clot so to plan this birth like I have one!!!
So....despite her astonishing ability to predict the future, she couldn't say that anything would be done in a hospital birth to change this supposed certain blood clot?!
Hmmmm.....I would either be:
a) refusing to give birth in the hosp where this consultant works, on the basis that they appear not to be able to do anything about any potential problems anyway - iow, should you choose a hosp birth (always remembering it's *your* choice), it will *not* be *that* hosp - or
b) recognising this for the shroud-waving it is & telling her (or the mws) that unless she comes up with hard evidence to back her claims, as well as a plan of action to handle any problems, you refuse to accept anything she says
In my family we have something called Leiden V - it's a marker which apparently shows your blood is more liable to clot.
We weren't alerted to this until after I'd had my 3 - last 2 homebirths. My eldest sister (3 homebirths) has never been tested. Sister no 2 has it - she had a hospital birth, very straightforward, heparin during and after pregnancy but no worries. Sister no 5 (yes I know - a monstrous regiment of women) also has it. Her baby was a hideous emergency c/s after lots of scare tactics and heparin after birth.
The consultant haematologist I saw at Southampton - a very nice woman with 5 children of her own - too the view that as I had already been exposed to lots of risk factors - the pill, childbirth etc - and hadn't had a clot, it was very unlikely I'd get one. She also didn't seem even slightly fazed by the prospect of another homebirth if I got pregnant again (which I haven't).
I'm not a doctor but it strikes me that if you've had one baby and were perfectly OK then it follows that a second one should be OK too.
Perhaps you could get an early discussion with a sensible haematologist - after all it is they, not obstetricians, who know about blood. Then you can at least make an informed choice. And you can always ask for a second opinion.
There was also a very useful Thrombophilia support group based up in Glasgow .. .. Maybe they have a website?
I've seen a haematologist regarding my "high" platelets and he felt that actually they were normal! The only thing he said was that I should have fortnightly blood tests to check that my platelets don't go above 600. They are 399 at the moment and it took 7 months for them to go from 350 to 400. With only 6 weeks to go they don't think there will be a problem.
Unfortunately the haematologist was anti-homebirth for any woman no matter what their risk but my midwives are still happy to go ahead provided my GP is happy to provide the heparin I need for labour before hand.
Now all I need to do is get the babe out of the breech position!!
I am feeling really cross after a phone call from my midwife who I haven't actually seen for 10 weeks!! I'm now 38 weeks.
I was due to have my homebirth visit tomorrow but she rang me to put me off. She told me I was high risk and couldn't have a homebirth, despite other midwives in the team being happy with it. She's also saying that I can't have a homebirth because she's not allowed to carry fragmine on her and I need to have that at the start of labour.
...I'm being treated as if I had clots in pregnancy and that I will definately have them!!!
My midwife is now trying to force me to deliver in hospital and is making me feel like I am doing something terrible by refusing "against medical advice".
I asked her if she could guarantee that I would have one midwife in attendance throughout labour and birth in hospital and be able to go home immediately, and she said yes. Call me a cynic but I don't believe a word of it. I had 8 different midwives last time (who got my notes mixed up with someone else's and didn't check drug allergies). I was told I could have a 6 hour discharge but I nearly "had" to stay for 2 days as the paediatrician was not on duty.
The midwife is now going to check with another consultant to see what to suggest but I know she is going to come back and tell me to go to hospital. I know I can just refuse to go in but they will purposely make life very hard if I do. Chances are they will refuse to send anyone.
Sorry to rant but I am sooo angry I could explode!!!
Announcing the birth of Cerys Phoebe O'Connell on 20th March 2002 at 00:43am, weighing 7lb 8oz.
She was born at home, one week late against the advice of the consultant who tried to stick her oar in again!
No complications during the birth except needing ARM (artificial rupture of membranes - breaking the waters) to help things along.
Thanks for all the support and advice over the last few weeks! This list has been so valuable and helped me to get the birth I wanted :-)
(The full-length birth story is here)
SAHM to Rosalyn (14/04/01) and Cerys (20/03/02)
Home Birth Reference Page